A Case for Diagnosis. Presented by Dr. O. H. Foerster and Dr. H. R. Foerster.
H. P., a white man, aged 32, a garage owner and mechanic, was presented because of a cutaneous eruption of two years' duration. The condition began with an inflammatory patch on the flexor surface of the left forearm attributed to irritation from gasoline. This lesion persisted, extended, and was followed by new lesions appearing on all the extremities, and lately, on the anterior surface of the trunk. The patient stated that all of the lesions had persisted, that they had been only moderately inflammatory, and at times scaly and occasionally pruritic, and that the condition reached its greatest intensity about three months before examination. The history was otherwise negative.Examination showed plaquelike, moderately infiltrated and slightly scaly patches, of a chronic inflammatory type, on the upper extremities, thighs and trunk. The oldest lesions, which were the largest, showed the most infiltration ; they were reddish-brown and sharply defined at the borders, presenting also gyrate outlines. The smaller lesions were irregular in outline, yellowishbrown, slightly infiltrated and scaly.The blood examination was as follows: white blood cells, 11,000; polymorphonuclears, 56 per cent; small lymphocytes, 30 per cent; large lymphocytes, 8 per cent; mononuclears, 5 per cent; transitionals, 1 per cent and red blood cells, 4,560,000. The examination of the urine gave negative results. A histologie section from the lesion on the left forearm was presented for examination.